Ferritin Levels and Restless Legs Syndrome (RLS)

[VVV]

I wonder if anyone has any recent good articles. I found one on levels in us older people that says the commonly accepted minimum blood level of 22 ng/mL may be low enough to cause or worsen RLS.

I just had my annual physical (it has been two years) and my results were 22 ng/mL and the paper from the doctor says the acceptable range is 22 - 322. The doc indicated my range is normal. We discussed my RLS at the physical and when I saw the lab results I thought the doc might recommend something to increase the ferritin level.

I have an appointment with the sleep doc next month and will definitely mention it to her. In the meantime do you have any experience with this or any references? Being on the very low end of the range is concerning to me.

Thanks,

[Lisaintosa]

Hello!

When you say Ferritin do you mean Iron? If so, i've noticed that since I started taking iron tablets, mine isn't as bad. I still have it mind you, but the bouts don't last as long and I haven't had to do laps around the livingroom in the middle of the night in some time.

Unfortunately, my doc can't seem to figure out why i'm low on iron because i've been on the pills for about a month now and it's not bringing it up. None of the meds i'm on can cause low iron. Any ideas on this one?

Thanks!

Lisa

[LSAT]

Hello!


Unfortunately, my doc can't seem to figure out why i'm low on iron because i've been on the pills for about a month now and it's not bringing it up. None of the meds i'm on can cause low iron. Any ideas on this one?

Thanks!

Lisa

Have you had your GI system checked? You could be losing blood in the stomach or in the colon. Have your stool checked for blood.

[deltadave]

http://www.rls.org/Document.Doc?&id=1296

http://www.idpas.org/pdf/4176.pdf

[VVV]

Hello!

When you say Ferritin do you mean Iron? If so, i've noticed that since I started taking iron tablets, mine isn't as bad. I still have it mind you, but the bouts don't last as long and I haven't had to do laps around the livingroom in the middle of the night in some time.

Unfortunately, my doc can't seem to figure out why i'm low on iron because i've been on the pills for about a month now and it's not bringing it up. None of the meds i'm on can cause low iron. Any ideas on this one?

Thanks!

Lisa

Yes, ferritin is the protein in the body that stores iron for the body's use. I use the term ferritin because it is listed that way on the lab report.

As for you having "low iron", here is some information on possible causes - http://www.mayoclinic.com/health/iron-d ... ION=causes

Good luck with that.

Do you mind saying which supplement you are taking; which dosage; and how often a doctor is checking your levels?

[VVV]

http://www.rls.org/Document.Doc?&id=1296

http://www.idpas.org/pdf/4176.pdf

Thank you.

Here is also the O'Keefe journal article - http://ageing.oxfordjournals.org/conten ... 0.abstract

The document from the RLS Foundation says in part,

Iron Deficiency
Serum levels of ferritin, the primary storage unit for iron,
have been found to correlate inversely with RLS severity.34,35
The lower the iron level and the more acute the onset of
symptoms, the more likely it is that improvement can be
expected in RLS symptoms with iron supplements. The
value of raising ferritin levels much above 50 μg/L remains
unclear. Iron treatment can be instituted with ferrous sulfate,
325 mg three times a day with 500 mg of vitamin C (to acidify
the stomach and promote absorption) or comparable doses of
elemental iron. In cases of actual iron deficiency (a diagnosis
which should be considered if serum ferritin is less than
30 μg/L) intravenous iron may be considered. Intravenous
iron improved RLS in open label trials80,81 but failed to do so
in one double-blind trial using an iron sucrose infusion.82
...
With the
institution of oral iron supplementation, serum ferritin levels
and percent transferrin saturation (%sat) should be checked
at intervals not longer than every three months. Supplemental
iron may be discontinued once the patient’s serum ferritin
level reaches 50 μg/L and should not be continued if
%sat >50% given the risks of hemochromatosis.83 Low
ferritin or anemia may also be a sign of bleeding and may
indicate the need for a workup. RLS has been the presenting
symptom of colon cancer.84

I gave the doctor the two O'Keefe links but sent the email before I saw this document.

It will be interesting to see my GP's reply and I will report back here. I wonder if he gets pissed off by patients giving him references like this?

Thanks again for the links.

[VVV]

Received this reply from the doctor at 6:00 a.m. this morning:

You certainly can take extra iron and see if it makes a difference. It might. You could get some ferrous sulfate or other iron forms either non-prescription or we can get you a prescription. Try it a couple of months and see if it helps.

I will follow the RLS foundation guidelines (link above):

Iron treatment can be instituted with ferrous sulfate,
325 mg three times a day with 500 mg of vitamin C (to acidify
the stomach and promote absorption) or comparable doses of
elemental iron. ... With the
institution of oral iron supplementation, serum ferritin levels
and percent transferrin saturation (%sat) should be checked
at intervals not longer than every three months. Supplemental
iron may be discontinued once the patient’s serum ferritin
level reaches 50 μg/L

I will have the level checked at 8 weeks.

In the meantime I have to think about what is causing the low levels of iron. I did have one precancerous colon polyp removed twelve years ago. Two followup procedures showed all clear. Another colonoscopy is scheduled for late next year on a five-year cycle. I might call the colon doc and ask whether given the situation the procedure should be advanced.

deltadave, thanks again for the link!

[deltadave]

de nada.

Rather than the colonscopy, you might just grab a couple of "Hemoccult" kits and get results in seconds.

[VVV]

A very nice development for me and I would like to give an update.

I started this treatment (http://www.rls.org/Document.Doc?&id=1296) roughly six weeks ago:

Iron treatment can be instituted with ferrous sulfate,
325 mg three times a day with 500 mg of vitamin C (to acidify
the stomach and promote absorption) or comparable doses of
elemental iron. ... With the
institution of oral iron supplementation, serum ferritin levels
and percent transferrin saturation (%sat) should be checked
at intervals not longer than every three months. Supplemental
iron may be discontinued once the patient’s serum ferritin
level reaches 50 μg/L

The improvement in my RLS symptoms has been dramatic. After two days improvement was already evident. After 30 days I felt like I was cured. The exception is the days when I get to the gym only by late afternoon or early evening. I lift heavy and hard and this timing causes me problems at night. If I finish at the gym anytime from early morning up to 3:00 p.m., I have little to no problem with RLS at night.

Last week I visited the sleep doc for a routine 6-month visit. She is fully supportive of what I am doing and uses the RLS Foundation guideline for all her patients. I asked her about the reason for low iron. She believes it is due to age and the bone marrow is not absorbing iron well. She expects that I will be on iron therapy (dropping to one tablet per day) for the rest of my life. She pointed out that my hemoglobin level is fine and this is an indication that I am not losing blood.

I will drop down to one iron supplement tablet per day next week. Hopefully my stores are replenished and this will become a daily maintenance dose. At some point in the near future I need to have another check of my serum ferritin because it should not become too high.

Over the last two weeks I slowly decreased the dosage of gabapentin to 1 x 300 mg daily. This last weekend I discontinued gabapentin entirely. That was an unpleasant experience and I was depressed for three full days - went into the attic looking for my old blues LPs. I also had vivid unpleasant dreams for three nights and was awakened many times during these nights. I feel sure this was gabapentin withdrawal and fortunately things have settled down very well the last two nights.

I noticed Monday I was getting increased reps in my workout and wonder if this was due to my system being free of gabapentin?


In brief, lessons learned and to be passed on:

1. If you have RLS have your serum ferritin level checked and if it is below 50 supplement using the RLS foundation guidelines.
2. If your serum ferritin level is below 50 ask you doc to review your hemoglobin level to make sure there is no hidden blood loss.
3. Ask the pharmacist to recommend the best OTC ferrous sulfate supplement. There were some funky looking brands on the shelf but the pharmacist gave me the brand he keeps behind the counter for people who come in with a prescription. The brand I have is from United Research Labs/Philadelphia and was dirt cheap at Target. Make sure to take vit C with it.
4. Many GPs may be unaware of the need to supplement below 50 serum ferritin level.

If you can't tell I am pretty damn excited about this personal development and hope to see my energy level increase and put more plates on the bar over the coming weeks. Travel schedule upcoming looks brutal so I really need this to work.

I typed this very fast while talking on the phone but will be happy to clarify any points if you have questions. It may take me some days to get back to the thread.

Thanks again to deltadave for pointing me to the RLS Foundation guidelines. My GP left me out to dry on this one. Thanks cpaptalk!

[jen4700]

Is low ferritin the same as being anemic?

[chunkyfrog]

Yes, specifically, iron deficiency anemia.
http://en.wikipedia.org/wiki/Iron-deficiency_anemia

[VVV]

Is low ferritin the same as being anemic?

Not exactly.

A low serum ferritin level can be a sign of iron-deficiency anemia as ChunkyFrog mentions.

The more common form of anemia is a low red blood cell count (low hemoglobin).

My hemoglobin is normal. My serum ferritin level is normal at 22. A patient in these circumstances would not be considered to have either kind of anemia.

However, if a patient has a serum ferritin level below 50, medical research has shown that it can cause or worsen RLS. So if the patient has problems with RLS it is recommended to supplement with ferrous sulfate to achieve and maintain a ferritin level of 50.

You don't say why you ask the question but if you have concerns you should discuss them with your doctor. You will need lab tests to get a diagnosis.

[kteague]

That's very good news! Reminds me that I'm long overdue for getting my ferritin level checked - been haphazard about taking my supplements.

So, since your nights are better, are you saying your PLMD is also improved?

[131]

Last time my wife had her serum ferritin level checked it was 42, she can't take Iron supplements as it makes her feel ill. She was taking 250mg of sifrol (Pramipexole) at night, which greatly reduced symptoms, but caused some negative obsessive behaviour. Reducing the sifrol to 125mg minimised the obsessive behaviour but also increased the incidence of RLS.

[Tom W]

I've found that the slow release Iron tablets are much easier on my stomach than the regular iron tablets. I've also found that if they do upset my stomach that skipping a day helps. Taking the supplements eliminated my RLS for the last 6 months and I've had no side effects compared to the Requip that I had been taking for it.